The federal Department of Justice (DOJ) recently announced a novel approach to accelerate its ongoing investigation of implanted cardioverter defibrillator (ICD) procedures performed outside of CMS’s National Coverage Decision (NCD).
DOJ seeks to accelerate ICD implant investigation
Several weeks ago, the Centers for Medicare and Medicaid Services (CMS) announced the scheduled January 1, 2012 launch of the Recovery Audit Prepayment Review demonstration project to improve payment accuracy for select inpatient services. The project is designed to conduct prepayment reviews to ensure medical necessity is documented and services are justified before receipt of payment for services rendered.
Although CMS recently clarified its policy by outlining the DRGs under consideration and timelines for implementation, the agency has now delayed implementation of the project altogether amid significant controversy and questions regarding the project’s scope and structure.
CMS clarifies, then delays, prepayment review demonstration
Building upon the success of the Medicare Recovery Audit Contractors (RACs) in recouping improper payments for potentially unnecessary health care services, CMS recently announced the “Recovery Audit Prepayment Review” demonstration to conduct prepayment reviews of certain health care services to ensure medical necessity before providers are reimbursed.
CMS doubles down on appropriateness with new prepayment review demonstration